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Nutrition for Children Ages Two Through Twelve

Holly Alley, MS, RD, LD
Nutrition Specialist,
Department of Food and Nutrition

Feeding children can be one of life's most rewarding, yet frustrating experiences! This sounds contradictory, but it's true. It's rewarding to see a child happily eating his favorite food, or to see him growing up healthy because you fed him well. But it can also be frustrating to spend time making a delicious meal, only to find that he won't touch it. As a parent or caregiver, you should know what foods children need for good nutrition, but you also need to know how to get your child to eat enough of those foods, and not too much of less nutritious ones. The key is teaching your child healthy eating habits.

Basic Nutrition Needs of Children

What foods do children need for good nutrition? There are many foods that can help give children the nutrients they need for good health. But no one food by itself contains all the nutrients in the right amounts. That's why variety in the diet is important. One way to get variety and be sure of getting all the nutrients is to serve foods from each different food group. This is about how much food children need from each of these food groups every day:

Serving sizes vary according to the age of the child and the food served. As a general rule, one serving of fruit, vegetable, cereal, or meat is one Tablespoon per year of age, up to 1/2 cup. In other words, a 3 year old would get 3 Tablespoons of rice for one serving, and a 4 year old would get 4 Tablespoons. Eight Tablespoons (or 1/2 cup) is considered one serving of rice for children over 8 years old and adults. A serving of milk is usually 1 cup, but a small child may not drink a whole serving at one time.

Common Nutritional Problems of Children

There are three major nutrition related problems that are common in children; iron deficiency anemia, tooth decay, and obesity.

Iron deficiency

Iron deficiency anemia is more common in children age 2-5, but it can occur at any age. Anemia causes children to become tired, irritable, pale, and have short attention spans. Severe cases can stunt growth and alter physical and mental performance.

There are several reasons why iron deficiency is so common in the preschool age group. First, preschoolers are growing rapidly and they need more iron than before. Second, many preschoolers may still be consuming a lot of milk which doesn't contain much iron, and excluding iron-containing foods. Some children dislike many food sources of iron such as green vegetables and red meats. Third, some children just eat so little that it's difficult to get all the iron they need. It's hard to get all the iron they need in a small amount of food because iron is not found in large amounts in any one food. It's necessary to eat several iron-containing foods each day in order to meet the need. Here are some food sources of iron:

Source: USDA Handbook 8

It is also hard to meet iron needs because most of the iron found in food is not easily absorbed. However, there are some things you can do to absorb more iron.

One thing you can do to help iron absorption is to eat a little meat, fish, or poultry with your meal. Meat, fish, and poultry are the best sources of iron. They contain more absorbable iron per serving than many other foods. In addition, they improve the absorption of iron from other foods that are eaten at the same time. So you can get more usable iron from other foods if you eat them with meat, fish, or poultry. Other animal foods, such as eggs and dairy products, do not help iron absorption.

Some plant foods, such as dried beans, peas, and lentils contain significant amounts of iron. To absorb more of it, eat foods that are a good source of vitamin C at the same time. Vitamin C rich foods, like citrus fruits, tomatoes, and some green leafy vegetables will improve the absorption of the iron in the other food. You can also get more iron by cooking in iron pots and pans.

Tooth Decay

Tooth decay is the most chronic nutrition related disease among children in the U.S. It's sad that many children have some form of tooth decay, because it could be prevented. One-half of all 4 year old children have some decay.

Tooth decay is the result of acids produced by bacteria found naturally in the mouth. The acids erode the enamel of the teeth, causing a cavity. Whether or not a cavity occurs depends on the strength of the teeth, brushing and flossing habits, and foods eaten.

Strong teeth can resist cavities better than weak teeth. A good diet helps make strong teeth. One mineral, flouride is especially important in making strong teeth. You can get flouride by drinking water that contains flouride. Find out if your drinking water contains flouride. You can also get some flouride from using toothpaste or mouth rinses with flouride.

Brushing and flossing are important habits to help prevent cavities. Brushing and flossing help keep the teeth and mouth clear of food and bacteria that can cause cavities.

Sugar and sweets are the primary decay producing foods. Sticky sweets, such as caramels, that cling to the teeth are more likely to cause cavities than foods that are quickly cleared from the mouth, such as sweet drinks. (However, sweet drinks are the major cause of tooth decay in babies and toddlers because the drink is often allowed to pool around the teeth when the child goes to bed with a bottle. Children should not be allowed to go to sleep with a bottle).

Frequent snacking on sweet foods increases the chances of decay. If sweets are eaten with meals, they are less likely to cause cavities.

Obesity

Obesity can be defined as being 20% over ideal body weight. Because children are growing so rapidly, it's hard to decide what an "ideal" body weight is at any specific age. However, it's estimated that anywhere from 10 - 25% of school age children are obese, and the numbers are increasing. Obesity is a health risk.

Obesity may result from simply eating too much. However, many children begin to overeat and become obese at a time of emotional trauma, such as the divorce of parents or the death of a family member. In many cases, obesity is a result of inactivity. One thing that contributes to inactivity is television. There is a relationship between the amount of time spent watching television and children's weights.

To prevent obesity, make sure your child is active. Plan ways for your child to run, jump, skip, hop, and move around. Organized classes or sports activities are possibilities, but just walking or bike riding are good activities too. Your child needs a chance for exercise every day. Establishing healthy eating habits will also help decrease the chances that your child will become obese.

Healthy Eating Habits

The eating habits that children form during childhood often last throughout their lifetime. Teaching your child healthy eating habits may affect their future health. We don't know for sure that we can reduce the risk of heart disease or other chronic diseases in adults by changing the diets of children. But changing the diets of children may establish habits that will have a strong effect on reducing their risk of heart disease as adults. Therefore, after the age of two, children's diets should be moderately low in fat, sodium, and sugar, just like adult diets.

How can you help establish healthy eating habits? First, it's important to help children learn to eat a variety of foods. This helps prevent deficiencies or excesses. Secondly, children should not be forced to clean their plates. Let them learn to recognize when they are full. They should make the decision about how much to eat, or even whether to eat. However, you have control over what is served and what foods are on hand. What you, as parent or caregiver, have on hand is probably the most important way to help your child establish good eating habits. Children are growing rapidly and need plenty of good food to help them grow. But they don't need "empty calories." Empty calories are foods that are high in calories (fat and sugar) without the protein, vitamins and minerals that should come with those calories. Help your children prepare and eat healthy foods by keeping your cupboards and refrigerator stocked with more nutritious foods. Kids will usually eat what's handy. They can't eat what's not there.

Here are some snack ideas: Have fresh and dried fruit on hand. Fruit canned in juice is also a good choice. Let them reach for made-ahead carrot sticks and other crunchy raw vegetables instead of chips and other fried snack foods. Broccoli, cauliflower, green pepper, and celery are favorites. (Even if your children don't like these vegetables cooked, that doesn't mean they won't like them raw). Dips made with beans, cottage cheese or yogurt give more nutrition for the calorie than sour cream dips. Popcorn is another good snack. It's easy for kids to make it themselves, too. For more nutrition, have parmesan cheese to sprinkle on it. Just be careful that small children don't choke on popcorn.

Graham crackers, vanilla wafers and homemade cookies where you control the ingredients make a good alternative to higher fat cookies and pastries. Frozen fruit juice and frozen fruit-flavored, low-fat yogurt on a stick are healthier substitutes for ice cream and other high-fat frozen desserts.

Try keeping a pitcher of water in the refrigerator for thirst quenching. Fruit juice and sparkling water are a healthy alternative to soft drinks. Don't forget reduced-fat milk. Remember kids will most likely drink whatever is available, so limit the times you have non-nutritious drinks in the house.

Sometimes the packaging sells the product. Look for milk and real fruit juice in the "ultra high temperature" (UHT) cartons with straws attached. These UHT packages are a lot like canned foods in a soft container. They don't need to be refrigerated until after they're opened. They're easy to grab on the run.

Other nutritious and convenient foods to have on hand are yogurt, unsweetened breakfast cereals, and nuts. Unique straws, eating utensils, and special napkins can also make eating healthy foods more fun.

More Healthy Habits

In addition to having healthy foods on hand, you can help establish good eating habits in your children by serving breakfast, serving snacks at least one and a half hours before a meal, and providing regular times for sleep and exercise.

Breakfast is the most important meal of the day. Children (and adults) need to refuel with breakfast in order to operate at peak performance. Studies support the idea that children who eat breakfast do better in school than those who don't eat breakfast. Eating breakfast can also help prevent overeating during the rest of the day. Many overweight people have the habit of skipping breakfast.

Breakfast does not have to be an elaborate meal. Cereal and milk, cheese toast, or fruit-yogurt shakes are fast breakfast ideas to help you and your children start the day off right.

Children need snacks to help them get all the nutrients they need during the day. However, snacks should not spoil their appetite for meals. Serving snacks one and a half to two hours before a meal will give a child time to get hungry again before the next meal.

A lack of sleep and/or exercise can affect a child's appetite. Be sure your child gets enough sleep and exercise during the day. Then he/she will be more likely to eat well.

A Common Misconception

Hyperactivity has become a popular word. And there have been many theories about what causes hyperactivity in children. Unfortunately, there are more theories than proof. After extensive research, we still haven't found a link between diet and hyperactivity.

Hyperactivity, or hyperkinesis, is "a consistent pattern of excessive inappropriate activity." The current name for this disorder is attention deficit disorder (A.D.D.). Somewhere between 2 to 10 percent of elementary age children have A.D.D. Most are boys. The child with A.D.D. is not just active. He also has a very short attention span, is easily distracted and easily frustrated. He may also have visual problems, lack some of the normal motor skills for his age or have psychological problems as well.

Traditional therapy includes psychological counseling for the child and the family, and drugs. The drugs are typically stimulants which have a reverse effect on hyperactive children. Many other treatments have been tried, but have not proven successful.

Diet first entered the picture in 1973 when Dr. Feingold, a pediatric allergist, proposed that hyperactivity was caused by allergies to salicylates (found naturally in some foods), artificial colors, artificial flavors, and other food additives. Although the diet he recommends is not nutritionally harmful (and in some cases it may improve family diets), controlled studies have not shown improvements in behavior of children following the diet.

The sugar-hyperactivity link may have come about because some high sugar foods like chocolates and soft drinks contain caffeine. Caffeine, a stimulant, can make normal children nervous, jumpy, more easily frustrated and more active. However, caffeine often has a calming effect on children with A.D.D., it does not cause A.D.D. Sugar does not appear to cause A.D.D. either. In fact, studies show a decrease in motor activity following a high sugar intake, both in normal children and children with A.D.D.

Numerous studies on large numbers of children with A.D.D. show no link between diet and the child's behavior. However, if you have a child with A.D.D., and you suspect a relationship between something in his diet and his behavior, the best thing to do is to is to set up an elimination-challenge situation for that child. Eliminate the food, or foods, you suspect. See if his behavior improves. If it does, then "challenge" him with that food to see if symptoms of A.D.D. reappear. This is the best way in an individual child to see if diet affects his behavior. Your doctor and dietitian can help you set up an elimination-challenge experiment. Then you will know for sure if it's worth the trouble to change your child's diet.

Summary

The key to keeping kids healthy is to start good eating habits. Try to do the following things every day:

• Serve the recommended number of servings from each of the food groups.
  
• Serve several iron rich foods.
  
• Serve less empty calorie foods.
  
• Make sure your child gets exercise.
  
• Serve breakfast.

USDA Agriculture Handbook 8, Composition of Foods, 1984-1988.

Satter, Ellyn, How to Get Your Kid to Eat, Bull Publishing Co., Palo Alto, Ca., 1987.

Monsen, Elaine, Iron nutrition and absorption: Dietary factors which impact iron bioavailability, J.A.D.A. vol. 88, no. 7, July, 1988.

Nutrition and the M.D., vol. 6, no. 4, 1980.

Lipton, M.A., and Mayo, J.P., Diet and Hyperkinesis--An Update, J.A.D.A. vol. 83, no. 2, 1983.

Reprinted with permission from the University of Georgia.
Alley, H. (1992). Nutrition for Children Ages Two Through Twelve. Athens, GA: University of Georgia, Cooperative Extension Service.

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